title: Predictors of recurrence and disease-free survival in patients with completely resected esophageal carcinoma.
abstract: OBJECTIVE
  The goal of this study was to analyze factors predictive of recurrence and disease-free survival in patients with completely resected esophageal carcinoma.
  
  
  METHODS
  We conducted a retrospective review of a prospective database to identify patients with completely resected esophageal carcinoma. Medical records were reviewed. Recurrence rates, time to recurrence, and disease-free survival were analyzed. The Kaplan-Meier method was used for time to event estimation, and multivariate Cox regression models were constructed to analyze factors thought to be significant in determining both freedom from recurrence and disease-free survival.
  
  
  RESULTS
  From 1988 to 2009, 465 of 500 patients underwent complete resection for esophageal carcinoma. Median follow-up for living patients was 49 months; 197 patients (42.4%) had recurrence, leading to 175 patients dying of cancer and 22 patients living with recurrent disease. Multivariate regression adjusted for P stage identified the following variables as independent predictors of freedom from recurrence: performance status greater than 0 (hazard ratio [HR], 1.84; 95 confidence interval [CI], 1.35-2.49]; P < .001), poor differentiation (HR, 1.50; CI, 1.12-2.01; P = .006), induction therapy (HR, 1.65; CI, 1.21-2.25]; P = .002), en bloc resection (HR, 0.61; CI, 0.43-0.88; P = .007), and advanced pathologic stages (II/III/IV) (HR, 5.46; CI, 3.05-9.78; P < .001). Independent predictors of disease-free survival adjusted for P stage were performance status greater than 0 (HR, 1.73; CI, 1.34-2.23; P < .001), en bloc resection (HR, 0.63; CI, 0.47-0.84; P = .002), induction therapy (HR, 1.34; CI, 1.02-1.76; P = .033), and advanced pathologic stages (II/III/IV) (HR, 3.16; CI, 2.15-4.65; P < .001).
  
  
  CONCLUSIONS
  For patients with completely resected esophageal cancer, independent predictors of improved freedom from recurrence and disease-free survival include good performance status, en bloc resection, and early pathologic stage.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10021, USA. pcl9001@med.cornell.edu
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.forename: Farooq M
authors.initials: FM
authors.lastname: Mirza
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009519:New York City; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome